Tag Archives: iraq

Military’s spotty recordkeeping hurts veterans

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

At the Center for Investigative Reporting, Aaron Glantz dug deep into the widespread recordkeeping errors and lapses that are bedeviling the VA’s disability claims system and making it difficult for veterans of Vietnam, the Gulf wars, and the war in Afghanistan to prove they were in combat, exposed to harmful substances, or even injured. A few days later, ProPublica and The Seattle Times published a similar investigation, which focuses most on more recent conflicts.

According to Glantz, “A Center for Investigative Reporting review of the VA’s performance data reveals chronic errors – committed in up to 1 in 3 cases – and an emphasis on speed over accuracy that clogs the VA system with appeals, increasing delays for all veterans.”

A few more numbers from Glantz’s work:

  • “The VA acknowledges it makes mistakes on 14 percent of disability claims.”
  • “A CIR analysis of 18 audits published this year by the VA’s inspector general shows the problem could be much worse, especially in high-profile cases. The analysis found a 38 percent average error rate for claims involving disabilities like traumatic brain injury and illnesses linked to the Vietnam-era defoliant Agent Orange.”
  • One internal VA document … shows that during the first three months of 2008 … the agency failed to perform its duty to assist in nearly 11,000 cases.

Likewise, the Seattle Times/ProPublica reporters write that military historians found that “at least 15 brigades serving in Iraq at various times from 2003 to 2008 had no records on hand. The same was true for at least five brigades deployed to Afghanistan.”

Records were so scarce for 62 more units that served in Iraq and 10 in Afghanistan that they were written up as “some records, but not enough to write an adequate Army history.” This group included most of the units deployed during the first four years of the Afghanistan war.

Medical, support network lacking for returning National Guard, reservists

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates social media efforts of AHCJ and assists with the editing and production of association guides, programs and newsletters.

National Guardsmen and reservists returning from duty in Iraq and Afghanistan “have been hastily channeled through a post-deployment process that has been plagued with difficulties, including reliance on self-reporting to identify health problems,” according to an investigation by graduate students in Northwestern University’s Medill School.

nat-guard-iraq

Photo by The National Guard via Flickr

Hidden Surge” found members of the National Guard must navigate disparate health care and support providers, made more difficult by the fact that many of them live in rural areas. Three of the stories were published in The Washington Post.

The reporters also found that, in the immediate aftermath of 9/11, most reservists were medically unready to deploy – an assessment made by a private contractor. “More than 2,400 Army Reserve soldiers were held back, at least temporarily, because of inaccurate assessments by the contractor, according to data provided by the Army Reserve Medical Command.”

Meanwhile, some soldiers with behavioral problems that could be aggravated by the stress of deployment and combat were improperly sent overseas.

The project, done by 10 students, was directed by faculty member Josh Meyer, who covered national security for the Los Angeles Times for 20 years. Students used video and interactive graphics to help tell the stories. A “How We Did It” sidebar says the students interviewed more than 150 people, reviewed documents and reports and traveled to nine states to do the reporting.

According to a press release, the Hidden Surge project is part of Medill’s National Security Journalism Initiative, funded by the McCormick Foundation.

Pentagon reluctant to provide therapy for TBI

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

After a lengthy investigation, ProPublica’s T. Christian Miller and NPR’s Daniel Zwerdling found that, in their words, the “battle over science and money has made it difficult for wounded troops to get a treatment recommended by many doctors for one of the wars’ signature injuries.”

They’re writing, of course, about traumatic brain injury, a consequence of roadside bombs in Afghanistan and Iraq. Their work revolves around a method of treating TBI and rehabilitating victims that has gained wide acceptance among civilian physicians and health plans but has not been embraced by the military’s insurance provider.

During the past few decades, scientists have become increasingly persuaded that people who suffer brain injuries benefit from what is called cognitive rehabilitation therapy — a lengthy, painstaking process in which patients relearn basic life tasks such as counting, cooking or remembering directions to get home.

Many neurologists, several major insurance companies and even some medical facilities run by the Pentagon agree that the therapy can help people whose functioning has been diminished by blows to the head.

Tricare provides health insurance for about 4 million active duty and retired soldiers, and “despite pressure from Congress and the recommendations of military and civilian experts,” it still refuses to cover cognitive rehabilitation therapy for the thousands of American soldiers afflicted by TBI.

Five of the 12 largest insurers cover the therapy, and an expert panel has recommended that the military do the same.

For its part, Tricare points to an assessment it conducted that put the effectiveness of cognitive rehabilitation therapy into doubt. I’ll let Miller and Zwerdling take it from there.

An investigation by NPR and ProPublica found that internal and external reviewers of the Tricare-funded assessment criticized it as fundamentally misguided. Confidential documents obtained by NPR and ProPublica show that reviewers called the Tricare study “deeply flawed,” “unacceptable” and “dismaying.” One top scientist called the assessment a “misuse” of science designed to deny treatment for service members.

The therapy would cost $15,000 to $50,000 per soldier, and the reporters found that, in private, Pentagon officials had expressed concerns about the massive cost of providing it to every suffering soldier. A few soldiers with political connections or ultra-motivated family members have managed to get the therapy, but its essentially off limits for most folks covered by Tricare.

Finally, a quick parenthetical mention answers a question that most health reporters are asking at this point. How did they get those internal studies and documents?

HINT: It involved finding a slightly less formal way to fulfill some of their FOIA requests.

(NPR and ProPublica obtained a copy of the ECRI reports through the Freedom of Information Act. However, Tricare denied access to reviews of the reports. ProPublica and NPR have appealed the request, but obtained copies of the reports and information on the reports from sources.)

PTSD or personality disorder? It matters to soldiers

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

The AP’s Anne Flaherty has put together a story that illuminates the Army’s refusal to admit that it could have misdiagnosed (and discharged) hundreds of soldiers who may have had PTSD or traumatic brain injury instead of a personality disorder. Keep in mind that a discharge for “personality disorder” means no veterans’ benefits and a lifetime of stigma. A diagnosis of PTSD or injury, on the other hand, means treatment will be covered by the government.

dentistPhoto by isafmedia via Flickr

The Army, for its part, has decided there’s nothing unusual about the following chain of events (taken from Flaherty’s story):

  1. The Army “discharged about a 1,000 soldiers a year between 2005 and 2007 for having a personality disorder.”
  2. In 2007, The Nation‘s Joshua Kors writes a cover story exposing the Army’s apparent habit of diagnosing soldiers with a personality disorder instead of considering the possibility of PTSD or traumatic brain injury.
  3. Soon after, “the Defense Department changed its policy and began requiring a top-level review of each case to ensure post-traumatic stress or a brain injury wasn’t the underlying cause.”
  4. Sure enough, “the annual number of personality disorder cases dropped by 75 percent.”
  5. At the same time, the number of post-traumatic stress disorder cases has soared. By 2008, more than 14,000 soldiers had been diagnosed with PTSD — twice as many as two years before.
  6. Army officials “reviewed the paperwork of all deployed soldiers dismissed with a personality disorder between 2001 and 2006″ and said they “did not find evidence that soldiers with PTSD had been inappropriately discharged with personality disorder.”

MSNBC tells of earthquake amputees, soldiers

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

In the aftermath of the Haiti earthquake, an MSNBC team has set out to cover, through a variety of media, an American prosthetic group working at a rural hospital to fit limbs to hundreds of earthquake amputees. At the same time, the team is sharing personal essays written by American soldiers who lost limbs in Iraq and Afghanistan. It’s an unusual post-disaster focus that has yielded some impressive stories.

Here are a few of the most notable dispatches:

More vets come home as result of psychiatric issues

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

On Shots, NPR’s Health Blog, Nadja Popovich reports on a recent Johns Hopkins study that found, more troops were evacuated from Iraq and Afghanistan in 2007 for mental health problems than for combat injuries.

The increase comes despite the military’s increased focus on combating mental health problems among American soldiers. The largest number of evacuated soldiers are still those diagnosed with “noncombat-related injuries, such as muscle and joint problems that come from carrying equipment,” but psychiatric evacuations are a growing and complex problem.

afghanistanAmerican paratroopers in Afghanistan. Photo by U.S. Army Spc. William E. Henry via Flickr

… those suffering from mental health issues had a remarkably low rate of returning to full duty. “Psychiatric conditions have the lowest return to duty rates among any diagnostic group aside from combat injuries,” (study leader Steven P. Cohen, an associate professor of anesthesiology at the Johns Hopkins School of Medicine and a colonel in the U.S. Army Reserve) wrote. “But the effects are much worse, because psychiatric conditions worsen the prognosis for all other conditions.”

“Patients with PTSD — as a rule — have multiple other complaints,” he continued. “Studies have shown that most people with persistent PTSD have ongoing musculoskeletal, neurological and constitutional complaints that are unlikely to respond to treatment.”

Related AHCJ articles

Interviewing ‘profoundly affected’ soldiers
Tips for interviewing service members returning from Iraq, the Middle East or Afghanistan